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Objective To compare the clinical outcomes between conventional percutaneous vertebroplasty (PVP) and targeted PVP in the treatment of osteoporotic vertebral compression fractures (OVCFs).Methods A retrospective cohort study was designed to review 215 cases of single level OVCFs hospitalized between January 2014 and December 2015.According to the procedure techniques,the patients were assigned to targeted PVP group (89 cases) and conventional PVP group (126 cases) which was further divided into sufficient filled subgroup (110 cases) and insufficient filled subgroup (16 cases) on basis of cement distribution.Key techniques of targeted PVP included accurate needle insertion to fractured area and cement injection using a push rob with a side opening.Operating time,cement injection volume,rate and types of cement leakage,cement distribution in the fractured area and visual analogue score (VAS) of back pain were compared between the two groups.Results Operating time in targeted PVP group was longer than that in conventional PVP group (P ＜ 0.05).There were no significant differences in cement injection volume and rate and types of cement leakage between the two groups (P ＞ 0.05).None in targeted PVP group showed insufficient cement distribution in fractured area,while 16 cases (12.7％) in conventional PVP group (P ＜ 0.05).No significant differences in preoperative VAS of back pain existed among targeted PVP group,sufficient subgroup and insufficient subgroup (P ＞ 0.05).VAS of back pain was significantly decreased after PVP in three groups (P ＜ 0.05).Difference in postoperative VAS of back pain between targeted PVP group and sufficient filled subgroup was insignificant (P ＞0.05).However,postoperative VAS of back pain in insufficient filled subgroup was significantly increased compared with targeted PVP group and sufficient filled subgroup (P ＜ 0.05).Conclusion Targeted PVP provides sufficient cement to fill the fractured area and decreases incidence of unsatisfactory clinical outcome compared with traditional PVP,indicating a secure and effective new technique in the treatment of OVCFs.
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BACKGROUND:There are many postmenopausal women taking hormone, which leads to much loss of bone mass, further inducing fragility fractures. The studies on the hormone exposure combined with ovariectomy-induced osteoporotic model are still immature, and the related molecular mechanism remains unclear. OBJECTIVE: To establish the rat osteoporotic model induced by ovariectomy combined with glucocorticoid exposure and to explore the underlying molecular mechanism. METHODS: Thirty 3-month-old female Sprague-Dawley rats were randomly divided into blank control, sham and model groups (n=10 per group). The rats in the blank control group received no intervention; rats in the sham group were clipped off a little of coeliac adipose tissue; the model rats received bilateral ovariectomy and 4-week administration of glucocorticoid. RESULTS AND CONCLUSION:At 4 weeks after modeling, compared with blank control and sham groups, the model group showed significantly lower bone mineral density of the femur, number of bone trabeculae and bone volume/total volume, and significantly wider bone trabecular spacing. Additionally, the model group revealed the damaged bone trabecular structure and thiner cortical bone. The expression level of Runx2 was downregulated whereas both collagen type 1α1 and peroxisome proliferators activated receptor γ mRNA were upregulated in the model group. These findings suggest that ovariectomized rats exposed to glucocorticoid rapidly develop femur osteoporosis, maybe by downregulating the expression of Runx2, as well as upregualting collagen type 1α1 and peroxisome proliferators activatedreceptor γ mRNA.
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BACKGROUND: In lumbar spondylolisthesis patients with severe osteoporosis, screw is easily loose and pul s out during reposition, or loss of reduction and internal fixation failure easily occur after repair. Therefore, it is very important to elevate the intensity of pedicle screw fixation during repair. At present, few studies concern application of bone cement screw enhancement technology in lumbar spondylolisthesis patients with osteoporosis. OBJECTIVE: To investigate the clinical value of augmented pedicle screw with polymethylmethacrylate for lumbar spondylolisthesis accompanied with osteoporosis. METHODS: From June 2009 to June 2011, 27 patients suffering from lumbar spondylolisthesis accompanied with osteoporosis were included in this retrospective study. These patients received augmented pedicle screw with polymethylmethacrylate. The levels of disability and pain were evaluated by Oswestry Disability Index and visual analog scale. The internal fixation and fusion were evaluated by radiological findings. Al complications were recorded. RESULTS AND CONCLUSION: Al cases were fol owed up for 15-37 months. Oswestry Disability Index and visual analog scale scores were significantly better in final fol ow-up than that pre-treatment (P < 0.05). Imaging results revealed that bone cement tightly connected to bone interface. The position of screw and bone cement was good. Symptomatic bone cement leakage was not found. No fixation failure was detected during final fol ow-up. Al patients achieved interbody fusion. These results suggested that polymethylmethacrylate bone cement could increase the gripping force of the pedicle screw in osteoporotic vertebral body. It is safe and effective to treat spondylolisthesis accompanied with osteoporosis with augmented pedicle screws. Satisfactory fixation stability and interbody fusion can be obtained.
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BACKGROUND:Posterior lumbar interbody fusion can thoroughly decompress the central canal, which is the common surgical technique for the central type of lumbar disc herniation with intervertebral instability at low lumbar segment. However, due to the regular traction on dural sac and nerve root in the operation, lower limb radicular pain in the early stage is inevitable. OBJECTIVE:To evaluate the effect of local use of gelatin sponge containing prednisolone acetate around the nerve roots after posterior lumbar interbody fusion on lower limb radicular pain. METHED:Sixty-three cases of lumbar disc herniation with degenerative instability were devided into treatment group (n=21) and control group (n=42) based on the type of implants. Gelatin sponge containing prednisolone acetate was implanted into patients in the treatment group after posterior lumbar interbody fusion, while pure gelatin sponge was implanted into patients in the control group. RESULTS AND CONCLUSION:Compared with the control group, radicular pain in the treatment group was significantly relieved within 1 week after surgery. The visual analog scale score and Oswestry disability index score were similar between the two groups. There were three cases of radicular pain recurrence in the control group, but no incision infection and epidural hematoma after surgery in both two groups. In conclusion, local use of gelatin sponge containing prednisolone acetate around the nerve roots can significantly relieve lower limb radicular pain in the early stage after posterior lumbar interbody fusion in lumbar disc herniation, contributing to early rehabilitation exercise and patient satisfaction outcomes.
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BACKGROUND:There are so many studies about ovariectomized rats at present, but the research on the change rules of bone mass, bone turnover markers, estrogen levels and their correlation in different periods of ovariectomized rats is rarely reported. OBJECTIVE:To analyze the change rules of bone mass, bone turnover markers, estrogen level and their correlation in different periods of ovariectomized rats. METHODS: Thirty-four 3-month-old female Sprague Dawley rats were randomly divided into three groups: baseline group, ovariectomized group and sham operated group. At the beginning of the experiment, the rats in the baseline group were sacrificed, then rats in the ovariectomized group and sham operated group were executed at 4, 8, 12 weeks postoperative respectively. The bone mineral density, bone mass content, area of different zones of the L1-3 lumbar vertebrae and femurs were detected by dual-energy X-ray absorption method, and meanwhile the serum levels of type I procolagen amino-terminal pro-peptide, I colagen carboxy-terminal peptide and estrogen were determined by ELISA. At last, we analyzed the correlation between body mass, bone mineral densityin vitro, type I procolagen amino-terminal pro-peptide, I colagen carboxy-terminal peptide and estrogen levels and the age of ovariectomized rats. RESULTS AND CONCLUSION: (1) The bone mineral density and bone mass content of the lumbar vertebral and femurs in the ovariectomized group were significantly lower than those in the sham operated group and baseline group at the 4th week after operation (P < 0.05). The bone mineral density and bone mass content in the ovariectomized group were ameliorated obviously at the 8th and 12th weeks compared with those at the 4th week after operation (P < 0.05). The bone mass loss was highest in the L1 and intertrochanteric regions. (2) Serum levels of type I procolagen amino-terminal pro-peptide and I colagen carboxy-terminal peptide in the ovariectomized group were significantly higher than those in the baseline group and sham operated group at the 4th week after operation, but there was no difference at the 8th and 12th weeks. (3) The serum estrogen level in the ovariectomized group was prominently lower than that in the sham operated group and baseline group at the 8th and 12th weeks after operation (P < 0.01 at the 8th week,P < 0.05 at the 12th week). (4) The age was positively correlated with body mass and bone mineral density of the lumbar vertebrae and femursin vitro, while the serum levels of type I procolagen amino-terminal pro-peptide and I colagen carboxy-terminal peptide were negatively correlated with the bone mineral density of the lumbar vertebrae and femurs in vitro (P < 0.01). These results suggested that the bone mass of the lumbar vertebrae and femurs in ovariectomized rats was decreased rapidly firstly, and then rose slowly with time; the bone mass in the L1 and intertrochanteric regions lost seriously; the bone turnover markers showed a significant increase at the beginning of ovariectomy and reduced gradualy to normal condition, while the estrogen level was increased at the first month after ovariectomy and then decreased rapidly. In addition, the body mass, bone turnover markers and estrogen level were associated with the change of bone mass.
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Objective To explore the characteristics and advantages of the rat model of lumbar nerve root com -pression established via modified hemilaminectomy approach .Methods Forty Sprague Dawley ( SD) rats were randomly divided into two groups ( experimental group and control group ) for establishing a rat model of lumbar nerve root compres-sion.Modified hemilaminectomy apprpoach was used in the experimental group , while total laminectomy was applied in the control group.Duration of operation, estimated blood loss, wound healing status, postoperative mortality, motor function of the lower extremities , pathological changes and the gray level of cytoplasmic TNF-αand IL-1 expression were observed to e-valuate the characteristics and reliability of the two operation approaches in establishing a rat model of lumbar nerve root compression.Results Compared with the control group , duration of operation , estimated blood loss , wound healing sta-tus, postoperative mortality were significantly better in the experimental group (P<0.01), whereas there was non-signifi-cant difference between two groups with regard to motor function of the lower extremities , pathological changes and gray lev-el of the cytoplasmic expression of TNF-αand IL-1 between the two groups .Moreover, the soft tissue structural alterations were reduced in the experimental group , which might be helpful for the rat postoperative rehabilitation .Conclusions Modified hemilaminectomy approach is a reliable alternative method for establishing a rat model of lumbar nerve root com -pression, which is beneficial to shorten the operative time , improve wound healing status , reduce estimated blood loss and damages of soft tissue , and decrease mortality rate .Moreover , this modified method is more consistent with the principles of animal ethics .
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Objective To compare the effects of gastric gavage and intramuscular injection of prednisone on the bone mineral density, skeletal biomechanical properties and bone metabolism in rats.Methods A total of 45 SPF rats were randomly divided into three groups:normal group, intragastric administration group, and intramuscular injection group.The normal group, as a control group, was administrated with normal saline 2 mL per day, both the intragastric administration group and i.m.injec-tion group received prednisone 0.5 mg/(kg.d) for 12 weeks.All rats were examined for bone mineral density (BMD) and the level of serum β-CTX and PINP.The femoral cortical biomechanical properties ( elastic load, maximal load, rupturing load) were measured by three point bending test.Results After 12 weeks, compared with the normal group, BMD and elastic load, maximal load, and rupturing load of the femur were significantly decreased.Compared with the intragastric gavage group, BMD was significantly decreased, while the elastic load, maximal load, and rupturing load of the femur were not significantly changed in the i.m.injection group (P＜0.05 for all).Compared with the normal group, the level of serum β-CTX was significantly raised (P＜0.05) and the level of serum PINP was significantly decreased (P＜0.05).Compared with the intragastric gavage group, the level of serumβ-CTX was also significantly raised (P＜0.05), the level of serum PINP was significantly decreased (P＜0.05), the bone trabecula and hemopoietic tissue were obviously decreased, while the adipose tissue increased obviously. Conclusions Both intragastric gavage and intramuscular injection of prednisone affect the level of BMD, skeletal biomechanical properties and bone metabolism.However, i.m.injection of prednisone decreases the BMD and bone strength more significantly, leading to a higher bone turnover with increased bone resorption, and leads to osteoporosis earlier.Our results may suggest that oral administration of prednisone is more safe in clinical treatment.
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BACKGROUND: Buqi tongluo prescription, which is characterized by invigorating qi and promoting blood circulation, dredging collaterals and dispersing stagnation, promoting tissue regeneration, and promoting blood circulation to remove obstruction in the collateral, can promote blood circulation at local injured part and ameliorate nutrien of nerve so as to accelerate axonal regeneration of peripheral nerve and functional recovery of nerve conduction.OBJECTIVE: To observe the effect of buqi tongluo prescription of various agents on recovery of nerve function after peripheral nerve injury and compare the results with the combination of vitamin B1 and B6.DESIGN: Randomized controlled animal study.SETTING: Department of Orthopaedics of the First Hospital Affiliated to Guangzhou University of Traditional Chinese Medicine.MATERIALS: A total of 48 Wistar rats of confined clean grade were selected in this study. After modeling on right sciatic nerve, rats were randomly divided into buqi tongluo capsule group, buqi tongluo parenteral solution group, vitamin group and blank group with 12 in each group.METHODS: All rats were cut their right sciatic nerve laterally, and then anastomosis in situ was used immediately to establish models of peripheral nerve injury. Administration began on the third day after operation once a day. ① Rats in buqi tongluo capsule group were perfused with powder of buqi tongluo capsule (including huangqi, renshen, danggui, chuanxiong and danshen which was diluted with saline) of 0.9 g/(kg·d) raw drugs (ig). ② Rats in buqi tongluo parenteral solution group were injected with 0.9 g/(kg·d) buqi tongluo parenteral solution (ip). ③ Rats in vitamin group were perfused with 15 mg/(kg·d) suspension (1.5 g/L) of vitamin B1 and B6.④ Rats in blank group were perfused with 0.01 mL/g saline.MAIN OUTCOME MEASURES: Four rats from each group were selected for 4, 8 and 12 week time points after administration to record bilateral nerve conduction velocity. Recovery rate was regarded as the ration between nerve conduction velocity at the injured side and nerve conduction velocity at the normal side.RESULTS: A total of 48 rats were involved in the final analysis. ① At each time point, nerve conduction velocity in two buqi tongluo prescription groups were faster than that in vitamin group and blank group (P ＜ 0.05, 0.01), and that in vitamin group was faster than that in blank group (P ＜ 0.05). ②At each time point, recovery rate of nerve conduction velocity in two buqi tongluo prescription groups was higher than that in vitamin group and blank group (P ＜ 0.05, 0.01), and that in vitamin group was higher than that in blank group (P ＜ 0.05).CONCLUSION: Both buqi tongluo capsule and buqi tongluo parenteral solution can promote recovery of nerve function after peripheral nerve injury, and the effect is superior to that of vitamin B1 and B6.
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[Objective] To investigate the therapeutic effect of early anterior bone grafting and internal fixation after focal cleaning and vertebral canal decompression for the treatment of tuberculosis of thoracolumbar vertebrae. [ Methods ] A retrospective study was carried out in 26 patients with thoracolumbar vertebral tuberculosis (TVT) who received early anterior bone grafting and internal fixation after focal cleaning and vertebral canal decompression. After treatment, the therapeutic effect was evaluated by observing the recovery of nerve function. [Results] The result of a follow-up ranging from 8 months to five years and 4 months showed that all the cases wi vertebral tuberculosis were cured, free from relapse. The internal fixation and bone graf(?)ing for fusion were good, and nerve function recovered, maintaining a good state. The nerve function of six patients with incomplete paralysis fully recovered. [Conclusion] Early anterior bone grafting and internal fixation after focal cleaning and vertebral canal decompression are effective to promote the recovery of nerve function of TVT patients. This regimen is capable of relieving or preventing spinal compression promptly, rebuilding the stability of the spine and presenting the focal diffusion, beneficial to the recovery of the patients.
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To investigate the etiological and pathological characteristics of adolescent lumbocrural pain, the findings of X ray, CT and MRI and biopsy in 67 cases of adolescent (14～28 years old) and 97 of the adult and the aged were compared. The results showed that the incidence of back epiphysis loop fracture of lumbosacral vertebrae was 40.74% (12/27) and 22.50% (9/40) in the teenage (14～18) and the youth (19～28) respectively, and 3.85% (2/52) and 4.44% (2/47) in the adult(28～60) and the aged (over 60) respectively, showing that the differences were significant between the adolescent and the adult(P 0.05 ). It is indicated that back epiphysis loop fracture of lumbosacral vertebrae is the specific pathological feature of adolescent lumbocrural pain. Therefore, it should be regarded as an important cause of adolescent lumbocrural pain.
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0.05 ), and the effect in Group A and Group B was superior to Group C(P
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[Objective] To investigate the effect of SKY expander vertebroplasty and KYPHON vertebroplasty for compression fracture of thoracic/lumbar vertebral body. [Methods] Twenty-one patients (group A) with compression fracture in 27 thoracic/lumbar vertebral bodies were enrolled to this study. Among them, 17 fractured vertebral bodies from 15 patients received SKY expander vertebroplasty and another 10 fractured vertebral bodies from 6 patients received KYPHON vertebroplasty. Thirty-three patients (group B) with compression fracture in 35 thoracic/lumbar vertebral bodies receiving conservative treatment during the same period served as the control. After treatment, the therapeutic effect and result of X-ray image were compared in the two groups. [Results] A follow-up ranging from 1 month to 11 months showed that pain in the loin and back, decrease of vertebral height, complications of leaking of bone cement, and bed sore (which occurred in group B) were not found in the patients receiving vertebroplasty. [Conclusion] SKY expander vertebroplasty and KYPHON vertebroplasty are effective and safe for compression fracture of thoracic/lumbar vertebral body, which can relieve the back and loin pain as soon as possible, reconstruct the vertebral body, decrease the occurrence of complications and promote the rehabilitation, and have a better effect than conservative treatment. For the two kinds of vertebroplasty, SKY expander vertebroplasty is economic and indicated for single vertebral fracture and old fracture, and KYPHON vertebroplasty is indicated for multiple vertebral fracture, severe fracture, and vertebral body fracture with end-plate broken.